Evaluating Ischemia Change in Stable CAD

A study published on July 9 in the Journal of the American College of Cardiology: Cardiovascular Imaging found that "in stable coronary artery disease (CAD), ischemia worsening is an independent predictor of death or myocardial infarction (MI), resulting in significantly improved risk reclassification when added to previously known predictors."

The authors write that "recent randomized trials have shown no improvement in death or MI with an early revascularization strategy compared with initial optimal medical therapy in patients with stable CAD." Since the independent prognostic significance of ischemia change is unclear, the authors aimed to evaluate the significance of ischemia change in stable CAD. The authors note that, "this is the largest reported series addressing changes in ischemia on serial myocardial perfusion single-photon emission computed tomography (MPS)."

Looking at "1,425 consecutive patients with angiographically documented CAD who underwent two serial MPS scans," ischemia change was calculated for patients undergoing medical therapy (MT) alone, percutaneous coronary intervention (PCI), or coronary artery bypass grafting (CABG).

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Results showed that "more MT patients (15.6 percent) developed ≥5 percent ischemia worsening compared with those undergoing PCI (6.2 percent) or CABG (6.7 percent) (p<0.001), and an "≥5 percent worsening ischemia was a strong, independent predictor of death or MI after adjustment for established predictors and irrespective of treatment arm. The addition of ≥5 percent worsening ischemia to traditional predictors resulted in significant improvement in the classification of risk for prediction of death or MI."


The authors conclude that their study "provides preliminary data suggesting that if patients have had two consecutive MPS studies performed for appropriate clinical reasons, the information regarding ischemia change may be used to improve prognostication in these patients."

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